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How to diagnose a frozen shoulder
For an experienced orthopaedic doctor or physiotherapist it's not hard to diagnose adhesive capsulitis or frozen shoulder. The story the frozen shoulder patient tells and the findings on examination are very typical and tend to be consistent from one frozen shoulder sufferer to the next.
Family doctors may have difficulty with the diagnosis of frozen shoulder because patterns of pain at the shoulder can appear similar to the inexperienced examiner.
All of the tissues that make up your shoulder come from the same development area of the growing embryo - the fifth neck segment. This means that pain from any of these "shoulder bits" is felt in the same part of the arm - and at times all the way to the wrist. This skin area runs down from the shoulder on the outer part of your arm, over the elbow and towards the base of the thumb.
What this means in practice is that it's not possible to work out what's wrong with a shoulder simply by asking where the sufferer feels the shoulder pain. Frozen shoulder, tendon injury, arthritis, bursitis and some other conditions all produce the same patterns of shoulder pain.
Even the neck can get in on the act at times. If the fifth nerve from the neck is inflamed or irritated then it can also send pain down the arm in the C5 area of skin.
Symptoms of Frozen Shoulder - it's a pain!
Pain is without doubt the cardinal and most problematic symptom in frozen shoulder. Many patients have told me that if it wasn't for the shoulder pain that the other symptoms would be little more than a minor hindrance to their day to day life.
The shoulder pain is felt in the C5 dermatome area and - as it becomes more severe - often seems to spread down that dermatome area towards the wrist. The opposite is true as recoveryfrom frozen shoulder takes place, when the pain seems to move back up the arm towards the shoulder.
The nature of frozen shoulder is that it follows a pattern of increasing shoulder pain until a plateau level is reached. The pain often then persists for many months at that level before eventually gradually easing off again until it settles completely.
Frozen shoulder pain is typically dull and toothache like. Sudden movements may trigger severe sharp shoulder pain which can be bad enough to make you feel nauseated or sweaty. These sudden movement pains can shoot all the way towards the wrist.
The pain of frozen shoulder is often made worse if you try to lie on the affected side at night or to use the arm above your head or behind your back. This can make dressing or personal care very difficult and time consuming.
As a general rule, the distance the pain spreads down the arm can be used to judge how irritated the joint is. Mild irritation causes tolerable pain near to the shoulder. Severe irritation will result in severe pain all the way to the wrist.
What a doctor looks for when examining your shoulder
These are the steps your doctor should take when examining your frozen shoulder symptoms.
Listen to your story
Your doctor needs to know how your shoulder pain started. Where is the pain and where does it spread to? Did you injure yourself? Have you overused the arm? Are there symptoms that might point to the neck as the source of the problem?
What activities or movements make the pain worse? What makes it easier?
How is your health in general? What about your previous health? Are you on regular medication? Do any other joints give you problems?
Look at the area
A careful doctor will undress you down to underwear when assessing frozen shoulder and will look for signs of muscle wasting or swelling
Check out your neck
You know by now that the neck can send pain down into the same C5 area as your shoulder. Your doctor needs to assess whether your pain could be arising from the neck - either completely or partly, both are possible.
Assess the shoulder
The shoulder must be assessed in a methodical manner. Your doctor will examine the joints and then the muscles in turn. With practice it's normally easy to work out where the problem lies.
If you have frozen shoulder then your doctor will find the "capsular" movement pattern described below.
If the problem arises in the muscles then your movement range will often be normal - but getting you to push against the doctor's hand will trigger the pain and may reveal weakness in the problem muscle.
The Capsular Pattern
Your shoulder can move in many directions but there are only three that are truly important when assessing whether someone has a frozen shoulder or not. A very typical pattern of movement restriction develops in frozen shoulder and this helps your doctor to make the diagnosis. This is known as the capsular pattern of the shoulder.
The picture below shows the most important movement test for assessing frozen shoulder. This movement is called external rotation and is typically very restricted in people with frozen shoulder.
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Shoulder Pain Treatment from Treatment-for.com
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